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Individual

OLIVER WILLIAM FANNIN III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
601 E 15TH ST, AUSTIN, TX 78701-1930
(512) 324-7000
Mailing address
807 CEDAR PARK DR, AUSTIN, TX 78746-4517

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
J7324
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
138853023
TX
01
138853024
CIDC
TX
01
8Y0017
BCBS OF TX
TX
Enumeration date
04/20/2006
Last updated
06/25/2009
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